Doctors in Berlin claim to have found a "cure" for HIV (BERLIN PATIENT, 2010) (TIMOTHY BROWN, THE BERLIN PATIENT, 2010)

Dec 18, 2010

Hi Dr. Bob.
I was on the internet and ran across this article:http://www.aidsmap.com/page/1577949/
I was wondering what you think about its potential and whether you think it holds up scientifically. I'm currently in medical school and am amazed by HIV.
This also makes me hopeful because I exposed myself to HIV through unprotected heterosexual vaginal sex (I'm the guy) and am getting tested today. I have a very bad feeling but this has made me hopeful that even if I am infected a cure may be found in my lifetime.

Take care and hope you are in good health!!

Response from Dr. Frascino

Hello,

We have been following the story of "The Berlin Patient" for a number of years. Due to a recent publication in the medical journal "Blood," the story has resurfaced with great fanfare. So it's time for an update on not only what happened, but also on what it all means. You asked if I thought the story "holds up scientifically." Yes, it does, but most people don't understand the whole story or it's potential relevance. Consequently, let me recap briefly.

Timothy Brown is an American with acute myeloid leukemia (AML) who was treated at the Charite-University Medicine Berlin in 2007. Mr. Brown developed leukemia after having been diagnosed HIV positive. Talk about bad luck! But his luck then changed big time! The treatment for AML involves chemotherapy, radiation therapy and stem-cell transplants. In essence the doctors needed to completely wipe out Mr. Brown's existing immune system and attempt to reconstitute it from scratch using donor stem cells. This is a very dangerous procedure with a significant morbidity and mortality rate. It's also incredibly expensive -- hundreds of thousands of dollars! (And that's if all goes well).

So how does this relate to an HIV "cure"? Glad you asked. This part gets a bit confusing, so pay attention. HIV needs certain receptors on cells in order to gain access to and infect immune cells. The most common type of receptor is termed "CCR5." If a cell doesn't have a CCR5 receptor, HIV viruses that require this receptor are essentially locked out. Put another way, the person lacking CCR5 receptor is immune to HIV virus requiring CCR5 to gain access and infect immune cells. A very small portion of the general population is lucky enough to have a mutation of the CCR5 gene that they inherited from both their parents (homozygous). Timothy Brown received a stem-cell donation from a donor who had the mutation and luckily his stem-cell transplant was eventually successful. (He had a relapse of his leukemia 13 months after the initial treatment and required a second round of treatment including another stem-cell transplant from the same donor.) As his new immune system grew, it too had the CCR5 mutation. Consequently, HIV-requiring CCR5 couldn't enter or infect new cells. Mr. Brown has now been off antiretroviral drugs for 3.5 years and shows no sign of HIV. It's an amazing story. But before you decide to fly to Berlin and ask for the same treatment, it's important to realize the following:

1. Not all HIV viruses require CCR5 to infect cells. Some viruses use an entirely different receptor (CXCR4).

2. Wiping out your immune system is extremely dangerous carries a significant risk that you could wind up dead as a doornail. It only makes sense when you have a disease like acute myeloid leukemia, which is already killing you quite rapidly.

3. Most folks do not have several hundred thousand dollars lying around, unless they're among the top 1% of Americans who will benefit from extending the Bush tax breaks for gazillionaires.

4. Finding someone with the delta 32 mutation that blocks CCR5 viruses from entering cells is extremely difficult. According to Tony Fauci, the head of the National Institute of Allergy and Infectious Diseases, only 1% of Caucasians and 0% of blacks have the mutation. Plus, you would need to find not only a donor with the mutation, but also a donor that was a "match" for you (immunologically compatible).

The bottom line is that this treatment will never be ready for prime time. It may, however, open new doors into research toward a cure that could. As always, we'll keep you posted as this story continues to evolve.

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